Self-reported listening-related effort and fatigue in hearing-impaired adults

Sara Alhanbali*, Piers Dawes, Simon Lloyd, Kevin J. Munro

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

111 Citations (Scopus)


Objective: Hearing loss may increase listening-related effort and fatigue due to the increased mental exertion required to attend to, and understand, an auditory message. Because there have been few attempts to quantify self-reported effort and fatigue in listeners with hearing loss, that was the aim of the present study. 

Design: Participants included three groups of hearing-impaired adults: (1) hearing aid users (HA, n = 50; 31 male, 19 female; age range = 55 to 85 years); (2) cochlear implant users (CI, n = 50; 26 male, 24 female; age range = 55 to 80 years); and (3) single sided deafness (SSD, n = 50; 30 male, 20 female; age range = 58 to 80 years). There was also a control group of adults who passed a hearing screen at 30 dB HL at the frequencies: 500, 1000, 2000, and 4000 Hz in both ears (n = 50; 22 male, 28 female; age range = 55 to 78 years). The fatigue assessment scale (FAS) was used to quantify fatigue. The FAS is a generic standardized self-report scale consisting of 10 items that are scored using a five-point Likert scale. An effort assessment scale (EAS), developed for the present study, consisted of six questions with responses provided on a visual analog scale that ranges from 0 to 10. 

Results: All hearing-impaired groups reported significantly increased effort and fatigue compared to the control group. The median fatigue score for the control group was 14 and around 22 for the three hearing-impaired groups. The median effort score for the control group was 20 and around 70 for the three hearing-impaired groups. There was no significant difference in mean effort or fatigue between the three groups of hearing-impaired adults. There was a weak positive correlation between fatigue and effort scores (r = 0.40, p < 0.05). The proportion of participants with extreme fatigue (scores above the 95th percentile of the control group) was 22, 10, and 22%, for the HA, CI, and SSD groups, respectively. The proportion of those with extreme effort was 46, 54, and 52%, for the HA, CI, and SSD groups, respectively. Results of factor analysis using the individual questions from both questionnaires indicated that the questions loaded into two factors: a "fatigue" factor for all of the FAS questions and an "effort" factor for all of the EAS questions. 

Conclusion: Hearing-impaired individuals report high levels of listening effort and fatigue in everyday life. The similarity in listening-related effort and fatigue between the different hearing-impaired groups suggests that these aspects of listening experience are not predicted by the severity of hearing impairment. Factor analysis suggests that the FAS and the EAS assess two distinct dimensions. The low correlation between FAS and EAS means that fatigue cannot be reliably predicted from self-reported effort in individual listeners.

Original languageEnglish
Pages (from-to)e39-e48
Number of pages10
JournalEar and Hearing
Issue number1
Publication statusPublished - Jan 2017
Externally publishedYes


  • fatigue
  • listening effort
  • self-report scales


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